Pharmacy Prior Authorization

Pharmacy fee for service Prior Authorization (PA)  Contacts

Change Healthcare Pharmacy PA Unit
Toll-free: 877-537-0722
Fax: 877-537-0720

Mississippi Medicaid Prescribers

Registered Users
If you are a Mississippi Medicaid prescriber, submit your prior authorization requests through the Change Healthcare provider portal.

All providers should register at the following link to submit prior authorization requests:

• Submit prior authorization request through the Change Healthcare provider portal

Those Without Web Portal Access
For Mississippi Medicaid prescribers who are unable to submit prior authorizations through the Envision web portal, fax your request to Change Healthcare Pharmacy PA unit.

Drug Prior Authorization Instructions

Pharmacy Reconsideration Request Form

Pharmacy Prior Authorization – Other Information and Forms

• Crossover Form B
• MedWatch Form
• Pharmacy Notification of Beneficiary’s Other Insurance Coverage
• Pharmacy Claim Form and Form Instructions